Form Osteopathy

🥙 Fuel sources for exercise 🍗

During exercise, skeletal muscle relies on various fuel sources to meet its energy demands. Glucose and lipids are the main sources.

Certain processes exist within cells that allow us to use glucose (carbs) and lipids (fats) to regenerate ATP (the molecule our cells use to create energy).

🔷 Glucose/glycogen 🔷

Muscle glycogen is particularly critical during high intensity activities as it provides an immediate source of glucose, allowing for quick bursts of energy.

Glycogen is stored in your liver and muscles and comes from carbohydrates in the foods you eat and drink.

The liver plays a crucial role in maintaining blood glucose levels by releasing glucose into the bloodstream, ensuring a stable supply of this essential energy source.

While glucose and glycogen are chemically similar, they serve distinct roles in providing your body with energy.

Glucose is a simple sugar and the primary energy source for your body's cells. It's always present in your bloodstream, ready to be used for immediate energy needs.

Glycogen, on the other hand, is the stored form of glucose – it is a complex carbohydrate that is primarily stored in the liver and muscles.

It serves as a backup energy reserve and is tapped into when available glucose levels start to decline, such as during fasting or with high intensity or prolonged physical activity.

🔷 Lipids 🔷

The body is also able to use fat (lipids) as a fuel supply, which is stored in within adipose tissue throughout our body.

Fat is a very rich supply of energy relative to its mass, which is why our body is good at storing a lot of it!

Like glycogen, lipids need to be broken down from their stored form into simpler molecules to be used for energy.

This is known as lipolysis. It takes longer for our body to perform this, which is why it is a more suitable fuel supply for much longer duration activities.

On the blog, accredited practising dietitian, nutritionist and sports dietitian, Holly Charlton, is taking us through how to fuel your training.

Before you begin exercising - whether it's running, surfing, spinning or lifting weights - what you eat and when you eat can significantly impact your performance and recovery.

As a dietitian, she has detailed the essentials of pre-exercise and post-exercise nutrition to help you make the best choices for your training goals.

Click the link to read now > https://shorturl.at/rN2MW

🏋️ How cardiac output is controlled when we exercise 🏊‍♀️

Change in our heart activity - in responses to oxygen demand due to exercise - is carefully controlled by our autonomic nervous system, which regulates all the involuntary functions in our body.

This automatic part of our nervous system has two key sub-systems: the sympathetic and parasympathetic systems.

The sympathetic system is responsible for our ‘flight or fight’ responses, and so upregulates activity i.e. increases heart rate and dilates blood vessels.

The parasympathetic nerves that innervate our heart, lungs and blood vessels downregulate activity.

All the automatic functions in our body require input from these two branches of the nervous system and the timing and degree of their input is governed by the feedback being received about the conditions throughout our body i.e. oxygenation, blood glucose, pain, etc.

❓Did you know?❓

Ventilation increases abruptly in the initial stages of exercise and is then followed by a more gradual increase.

This increase is as large as from 5 – 6 litres per minute at rest, to over 100 litres per minute.

The respiratory rate may even stay elevated for 1 – 2 hours after intense exercise, due to the body’s ongoing need for oxygen as recovery processes commence.

💪 What muscles are involved during exercise? 🏃

Exercise means we are moving, and our muscles are contracting. Exercise stimulates the sympathetic nervous system, causing the body to respond as a whole.

This response helps maintain homeostasis to meet the higher physical, metabolic, respiratory and cardiovascular demands placed on our body through exercise.

When we exercise, our body's systems are intricately involved to support the increased demand for energy and oxygen.

Three types of muscles play a crucial role in this process - skeletal, smooth and cardiac muscles.

🔷 Skeletal muscles: these are the muscles we consciously control during strength workouts, such as the hamstrings, pecs and biceps. They enable movement by contracting and working in tandem with our tendons and bones.
🔷 Smooth muscles: smooth muscles are involuntary and function automatically without conscious effort. Their presence within our blood vessels enables control of vascular dilation and constriction i.e. blood flow.
🔷 Cardiac muscles: are only found within our heart and are involuntary muscles. These are what create the pumping action of our heart.

On the blog we explore what happens in our body when we exercise.

This is more than just the visual physical changes that occur, but what happens inside our muscles and cells, as there are a host of adaptative responses that result in improved fitness, health and performance.

We look at:

🔷 The different muscles involved during exercise
🔷 Respiration and ventilation
🔷 What happens in our cardiac system
🔷 Body temperature
🔷 How fuel is utilised

These adaptations can improve future physical performance and positively impact life expectancy, mood, sleep quality, concentration levels and reduce the rate of injury.

The physiological responses to exercise are dependent on the intensity, duration and frequency of exercise - as well as environmental conditions - and is unique to every individual.

Click the link to learn more about how training adaptations result in changes in our bodies > https://shorturl.at/3gJTC

🔷 Why metabolic flexibility is good for you 🔷

Metabolic flexibility is the body's ability to efficiently switch between fuel sources, such as glycogen (carbs) and fat.

Here’s why this is crucial:

🔷 Fuel efficiency: fat is an energy-rich fuel that doesn't weigh much. If our bodies stored all energy as glycogen, we'd double our weight! Fat storage is a more efficient way to store energy.
🔷 Optimised performance: being able to tap into both glycogen and fat during workouts means better endurance and sustained energy levels. This flexibility allows for improved performance and recovery.
🔷 Health benefits: enhancing metabolic flexibility can help in managing weight, reducing the risk of metabolic diseases, and improving overall metabolic health.

During a given training session, your ability to switch between fuel sources ensures you have sustained energy and can manage longer and harder sessions.

🏃‍♀️ Maximise your exercise with heart rate zone training 🏃‍♂️

By training within specific heart rate zones, you can stimulate targeted adaptations in your muscles and cardiac capacity.

Below, we have outlined the widely used 5-zone system, with intervals based upon maximum heart rate percentage.

Adjustments to these zones can be made on most fitness devices, if you don’t feel they match your level of fitness (check our stories).

To understand your zones more accurately, an athlete or individual can undertake a blood lactate test to determine your lactate threshold.

Your lactate threshold is the point at which lactate is produced and accumulates in the blood at a faster rate than it can be removed - which leads to fatigue.

You may also come across the 3-zone system, which is a refined version of the 5-zone system, used more often in the scientific community due to its emphasis on key physiological thresholds.

Here's a quick guide:
🔷 Zone 1 (50 - 60% of max HR): ideal for recovery and warm-ups. It helps improve overall cardiovascular health without putting too much strain on your body.
🔷 Zone 2 (60-70% of max HR): perfect for building endurance. Training in this zone over long durations enhances fat metabolism and increases the number of mitochondria in your muscle cells, boosting your aerobic capacity.
🔷 Zone 3 (70 - 80% of max HR): this is the sweet spot for improving aerobic fitness and muscular endurance. Workouts in this zone help increase the efficiency of your heart and lungs.
🔷 Zone 4 (80 - 90% of max HR): focuses on increasing your lactate threshold (a useful measure for deciding exercise intensity). Training here enhances your body's ability to clear lactate, allowing you to sustain higher intensities for longer periods. For the more conditioned individual, 85%+ max HR is best.
🔷 Zone 5 (90 - 100% of max HR): best for peak performance and anaerobic capacity. Short bursts of high-intensity workouts in this zone improve your speed and power, but should be used sparingly to avoid overtraining.

By incorporating heart rate zone training into your routine, you can work out at the right intensity to meet your specific fitness goals.

Resistance training: time under tension/tempo training

Small changes in training methods can lead to big differences in how our body adapts.

One example is increasing the total time under tension a muscle undergoes during a resistance training session.

But to properly implement this training method, we need to consider the types of contractions a muscle performs at various phases of a movement.

For example, when using a bench press, your pectoral muscles will be:

• Shortening when you push the bar away, which is a concentric contraction.
• Lengthening as you lower the bar to your chest, which is an eccentric contraction.
• Maintaining a static length (but still working) whenever you pause the movement - such as the lowest or highest point of the lift, which is an isometric contraction.

When we perform a lift (like a bench press) we may complete the movement without giving much thought to the time taken from start to finish.

Tempo training involves increasing the duration (or time under tension) of an individual repetition. Often this will involve prescribing a specific time to complete the concentric and eccentric phase (and perhaps even the isometric phase).

Using the bench press as an example again, this may involve:

• 3 - 4 seconds to lower the bar from rack to chest (eccentric).
• 1 - 2 second pause at the bottom (isometric).
• 2 - 3 seconds to push the bar away (concentric).

The impact of tempo training is that it increases the total time the muscles are working, leading to greater muscle damage and subsequent growth.

This enhances muscle endurance and stimulates hypertrophy more effectively.

In addition to prescribing tempo, a higher number of repetitions per set will also increase overall time under tension.

This approach to lifting may be a helpful addition to an overall strength program – not necessarily to replace performing lifts with a steady, more natural rhythm.

🏃‍♀️ Fuelling for training adaptations 🏋️

Fuelling your muscles goes beyond the workout itself.

Adequate protein intake is crucial not only for performance but also for the adaptations that occur in your muscles long after your training session ends.

Here's why:

💪 Muscle Repair & Growth:
🔷 Protein synthesis: After you exercise, your muscles undergo repair and growth, a process driven by protein synthesis. Consuming enough protein provides the building blocks (amino acids) needed for this process.
🔷 Muscle hypertrophy: adequate protein intake supports muscle hypertrophy by facilitating the repair of damaged muscle fibres and the growth of new ones.

💪 Fuel Utilisation After Exercise:
🔷 Fat breakdown: after a workout, your body continues to burn fat for hours as it repairs and rebuilds muscle tissue. This process, known as excess post-exercise oxygen consumption (EPOC), requires energy and is supported by protein intake.
🔷 Metabolic adaptations: Regular protein consumption helps maintain and increase your metabolic rate by supporting muscle mass, which in turn enhances fat oxidation even at rest.

💪 Hormonal Support:
🔷 Insulin and growth hormone: protein consumption stimulates the release of insulin - which helps shuttle amino acids into muscles - and growth hormone - which supports muscle repair and growth.

💪 Recovery & Immune Function:
🔷 Recovery: adequate protein intake reduces muscle soreness and accelerates recovery, allowing you to train more effectively and frequently.
🔷 Immune support: protein supports immune function, which is crucial for recovery and overall health, especially when training intensively.

How to grow muscles/muscle hypertrophy

Here’s a breakdown of the key factors that help achieve optimal muscle hypertrophy.

💪 Time Under Tension
🔷 The longer your muscles are under tension during each exercise, the more stimulus they receive for growth. Aim for a slow, controlled tempo in both the concentric (lifting) and eccentric (lowering) phases of your lifts when lifting weights.

💪 Strength Training
🔷 Sets and reps: for muscle growth, target 3 – 6 sets of 6 – 12 repetitions per exercise. This range maximises the hypertonic response by balancing intensity and volume.
🔷 Progressive overload: gradually increase the weight you lift over time. This ensures continuous adaptation and muscle growth.

💪 Volume & Frequency
🔷 Training volume: the total weekly volume (sets x reps x weight) is a crucial factor. Higher volumes generally promote greater hypertrophy.
🔷 Frequency: train each muscle group 2 - 3 times per week. This provides enough stimulus for growth while allowing adequate recovery.

💪 Nutrition & Recovery
🔷 Protein intake: consume adequate protein for your body weight to support muscle repair and growth.
🔷 Rest and recovery: ensure you get enough sleep and rest days to allow your muscles to recover and grow.

💪 Variety in Training
🔷 Exercise selection: incorporate a variety of exercises to target muscles from different angles and promote balanced growth.
🔷 Change it up: cycle through different training phases (e.g. hypertrophy, strength and endurance) to prevent plateaus and keep your muscles challenged.

By focusing on these key factors, you can optimise your muscle growth and achieve your training goals.

In our last post we looked at specific changes (adaptations) that occur within our muscles in response to either strength or aerobic training.

Although we can improve our strength and aerobic capacity through training, our genetics play a big role in determining our ultimate potential.

We see this amongst our friendship groups, training buddies and in elite athletes - some people may be naturally gifted at running fast, where some can run for much longer than others, even without any training.

One key influence on this natural inclination towards power or endurance is the composition of fibre types within our muscles.

Our muscles are a collection of individual muscle fibres that contract together (they look almost like a bunch of spaghetti).

There are two key muscle fibre categories – fast and slow twitch.

Slow twitch fibres contract relatively slowly but have the capacity to do so repeatedly over a long time. They are therefore suited for endurance activities.

Fast twitch fibres (there are two types) are capable of powerful and rapid successive contractions, but tend fatigue quickly. They provide our capacity for power and strength.

Each of our muscles will have a mixture of these three fibre types, depending on our genetic makeup, and on the specific function of that muscle (e.g. our postural muscles have a high percentage of the fibres that are good for endurance).

There is evidence to suggest that we can alter the composition of fibres in our muscles, but genetics will determine how much of a shift can occur.

So, let’s take a look at the three fibre types and why they provide particular advantages:

🔷 Type 1 (slow twitch): contract slowly and produce energy slowly but efficiently.
🔷 Type 2a (fast twitch oxidative): contract quickly and produce energy slowly but efficiently (similar to slow twitch).
🔷 Type 2b (fast twitch glycolytic): contract quickly and produce energy quickly to facilitate quick subsequent contractions but fatigue more quickly.

Understanding the composition and function of our muscle fibre types can help us tailor our training programs to maximise our strengths and address our weaknesses.

What happens to our muscles when we train?

Changes to our muscle occur when we train. We call these muscle adaptations.
On a cellular level, these adaptations include changes to the store of nutrients, the amount and type of metabolic enzymes, the amount of contractile protein and the stiffness of the connective tissue.

Physically, these adaptations can lead to muscle growth, increased strength, enhanced endurance and more.

Depending on the type of training you do, here’s what can happen to your muscles:

Strength training:
🔷 Muscle hypertrophy: increase in the size of your muscles due to growth of the muscle fibres.
🔷 Increased strength: your neuromuscular system becomes more efficient, enhancing your ability to generate force.
🔷 Fibre type composition: there can be a shift from one type of muscle composition (fibre types) towards another that is more fatigue resistant.

Aerobic training:
🔷 Enhanced endurance: your muscles become better at using oxygen due to an increase in mitochondrial density (your mitochondria play a key role in energy production).
🔷 Improved blood supply: capillary density increases, providing your muscles with more oxygen and nutrients.
🔷 Metabolic adaptations: changes that enhance your body’s ability to produce energy efficiently and sustain long periods of exercise.

Both types of training are essential for a balanced exercise routine to help build strength and endurance.

The liver plays an important role during exercise as the liver is an essential metabolic organ – it governs the body’s energy metabolism.

The liver acts as a hub to metabolically connect various tissues, such as skeletal muscle and adipose tissue.

As food is ingested, glucose, fatty acids and amino acids are absorbed into the bloodstream and transported to the liver.

The liver stores, releases and recycles this energy to be used throughout the day, and during exercise.

The accelerated metabolic demands of the working muscles (i.e. during exercise) can’t be met without a robust response from the liver.

Exercise would result in hypoglycemia (low blood sugar) if it were not for the accelerated release of energy as glucose by the liver.

On the other hand, if your blood sugar levels increase (for example after a meal), the liver removes sugar from blood, supplied by the portal vein, and stores it in the form of glycogen.

The hormone insulin is involved in this strict monitoring of blood glucose levels.

Keeping blood glucose levels consistent is important for preventing serious health problems and to improve energy.

The liver responds to regular exercise by increasing its capacity to produce energy by oxidising fat.

This in turn can reverse fatty liver damage and improve the metabolic health of the liver.

🏃‍♂️What happens when we exercise? 🏃‍♂️

Here are some fun facts about how our body uses different fuel sources to power our activity.

Fuel utilisation in the body:
🔷 ATP is the molecule our cells use to create energy. Every time it releases energy (i.e. for muscle contraction) it needs to be regenerated for ongoing use.
🔷 There's a short supply of another chemical within cells known as phosphocreatine, which can rapidly rebuild ATP making it suitable for short bouts of high-intensity efforts. But, it will be depleted after about 10 seconds.
🔷 After this, glucose kicks in, which is readily available in our blood stream. There is a chemical pathway by which it (as well as fats) rebuilds ATP to ensure an ongoing supply of energy.
🔷 As this is used up, the drop in blood-glucose levels then prompts the liver to convert glycogen (the stored form of glucose) into glucose to maintain blood glucose levels. This also results in a further supply of blood glucose available for the muscles to use.
🔷 Simultaneously, involved muscles will mobilise their own stored supply of glycogen, converting it to glucose, which works to rebuild ATP.
🔷 If exercise continues at a low intensity, our available glucose and glycogen may deplete to levels that prompt the body to look for an alternative fuel source i.e. fatty acids. These are stored in adipose tissue within the body.
🔷 Fats are energy-rich molecules but aren't as efficient at providing energy. As such they are a primary fuel source for low-intensity exercise.
🔷 This impressive ability to efficiently utilise and move between the available fuel sources throughout exercise is known as ‘metabolic flexibility’.

The way that our body responds to training is quite remarkable.
We refer to these changes as physiological ‘adaptations’, and they are what allows us to get faster, stronger, have a higher aerobic capacity and more.

Not only do these changes improve our physical capabilities but result in the positive changes that correlate with longevity and overall improved health.

This month we will explore some of the changes that occur in our body’s system, and at a cellular level when our bodies undergo the physical stress of exercise.

Depending on the type of tendinopathy injury you are experiencing, there are specific treatments we may apply to treat the affected tendon.

🔷 Patellar tendinopathy (knee)
Eccentric strengthening exercises focusing on the quadriceps and the patellar tendon are often prescribed. Additionally, patellar tendon straps or braces may provide symptomatic relief by offloading the tendon during activities.

🔷 Achilles tendinopathy (back of the calf/heel bone)
Eccentric calf exercises, such as heel drops, are helpful in managing an Achilles tendinopathy. Modalities like eccentric loading programs, shockwave therapy, and PRP (Platelet-Rich Plasma) injections have shown promising results in reducing pain and improving function.

🔷 Lateral elbow tendinopathy (tennis elbow)
Eccentric wrist extensor exercises, grip strength training and addressing biomechanical factors contributing to wrist and forearm strain are key in managing lateral elbow tendinopathy. Modalities such as shockwave therapy and PRP injections may also be considered.

These are examples of some treatments that may be applied when looking at a specific tendinopathy.

It’s essential that early intervention by a registered practitioner is done to assess your injury before performing any rehabilitation exercises.

When tendon pain develops, it's essential to modify the training approach to prevent exacerbation of symptoms and promote recovery.

The key goal in recovering from a tendinopathy is to improve the capacity of the tendon and muscle to manage load.

Here are some training modifications you can implement while recovering from a tendon injury >

The best way to ensure you don’t experience a tendon injury is to focus on goal setting and plan out a training program that focuses on your goals without overdoing things.

Tendinopathies occur when you accelerate your training program too quickly, so planning out a program that fits both your goals and your ability is essential.

If you want to learn more about goal setting, check out our blog post on the website > https://bit.ly/3HcAFxW

There are some helpful pointers on health and fitness benchmarks to consider when planning out your training goals.

Early intervention plays a crucial role in the management of tendinopathies, preventing further progression of the condition.

There are several key strategies we consider when treating a tendinopathy.

These include:

🔷 Load management: gradually modifying activity levels to reach an optimal load level.
🔷 Eccentric exercise programs: isolated, slow lengthening muscle contractions.
🔷 Manual therapy: soft tissue mobilisation, myofascial release and joint mobilisation.
🔷 Biomechanical assessment: helps to understand the condition and prescribe relevant rehabilitation plan.

If you think you’re experiecing a tendinopathy injury, reach out and book a treatment so we can best assess your return to full strength and mobility.

In the first part of our two-part series on tendinopathies, we explored the structure and function of tendons, the disease process of tendinopathies and characteristic signs.

Now, we investigate how to manage tendinopathies, focusing on early interventions, modifying training approaches and specific treatments for key tendinopathies like patellar, Achilles and lateral elbow tendinopathy.

An essential read for athletes or anyone embarking on a new training program.

Click here to read now > https://bit.ly/49ChXvp

Managing tendinopathies (part 2) — Form Osteopathy Here we investigate how to manage tendinopathies, focusing on early interventions, modifying training approaches and specific treatments for key tendinopathies.

Dynamic stretching is an important aspect of preparing your body for exercise.

Dynamic stretching helps to warm up the tendons before engaging in exercise, helping to reduce the likelihood of a tendon injury.

Dynamic stretching involves the active shortening and lengthening of the muscles.

It prepares the body for the upcoming exercise by gradually increasing the range of motion and activating the muscles that will be used during the activity.

This dynamic stretching routine helps prepare the body for the task ahead, as muscles and tendons will be subjected to repetitive stretch and shortening movements, often with high force.

If you want to learn more about dynamic stretching, search ‘dynamic stretching’ on our blog or DM us and we’ll send you the link.

🏃‍♂️ “How many treatments will this take?”🏃‍♂️

Treatment dosage, particularly as it relates to hands-on techniques, is an important consideration and a discussion that your practitioner will have with you regarding your recovery.

There are many acute pain presentations that will just about resolve completely within a single treatment session, however for other conditions, we may need to apply the treatment approach repeatedly to break the pain cycle.

Throughout this we are also very aware of the natural recovery process that is occurring, and together with our patients evaluate the effectiveness of hands-on treatment, in conjunction with active interventions, in restoring them to full health.

We also realise that although pain levels might improve rapidly for some, that there may be biomechanical imbalances that have contributed to the onset of injury.

For this reason, we will work with our patients beyond the resolution of pain, until a point we are both satisfied they are moving optimally and taking care of their body day to day, in an appropriate way.

🔷Our treatment process 🔷

When you come in for a treatment, depending on your condition, we will perform a range of techniques to help manage your pain and restore you to mobility.

This may include hands-on techniques such as movement, massage, stretching, joint manipulation, and postural and positioning advice.

Dry needling is also an important tool in our arsenal, as it greatly assists in decreasing pain and improving function through the release of myofascial trigger points (knots in the muscle).

Exercise rehabilitation is a key part of an active recovery, and we advise on specific rehabilitation exercises to help aid your healing process. These should be performed on a regular basis at home, between appointments.

For many conditions, follow up treatments are an essential part of the recovery process, helping restore you to full mobility and go about your life pain-free.

Your practitioner will determine during your appointment if a follow up is necessary (treatment dosage) or if your injury can be managed through continued exercise rehabilitation.

There are many factors that can lead to a tendinopathy injury.

The result of these combined influences is a gradual degenerative change in the tendon structure.

This process begins with damage to the collagen fibres within the tendon. As the condition worsens, cellular behaviour in the tendon is altered, which then affects its ability to repair and remodel, leading to further loss of tendon health.

Swipe for an overview on some of the common triggers that can lead to a tendinopathy injury.